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Background The cornerstone of the nursing profession is moral identity, and the establishment of professional identity goes hand in hand with moral growth. The existing state of affairs and the elements affecting nursing students' moral identity are not well understood from a multifaceted perspective.Objectives To define moral identity subgroups and research the variables affecting profile membership.Methods A convenient sampling. was used to conduct a cross-sectional study among nursing students from November 16th, 2022, to January 17th, 2023. The Moral Identity Measure and the General Demographic Information Questionnaire were provided to the participants. Students studying nursing were divided into several moral identity subgroups using a latent profile analysis (LPA). To determine the variables connected to the putative moral identity categories, we also conducted ordinal and multinomial logistic regression analyses.Results A total of 10583 nursing students responded to legitimate surveys. The LPA results validated the presence of three unique moral identity profiles: low (4.2%), moderate (41.9%), and high (53.9%), and demonstrated that the three-profile model was the most appropriate. The three profiles stood out from one another greatly. Profiles were predicted by gender, grade, political stance, rural background, leadership experience, and junior college degree.Conclusion In this study, three profiles were found, and the majority of nursing students had a strong moral identity. Regarding variables determining profile membership and moral identity subgroups, nursing students should get specialized support.

Background Health behavior is a crucial tool for secondary stroke prevention. However, stroke patients have low health behavior. Understanding the factors associated with health behavior influence them is essential to improve their health behavior.Objectives To explore the association between perceived social support and health behavior among stroke patients and the mediating role of recurrence risk perception in this relationship.Methods 254 stroke patients were investigated from June 2021 to August 2021. Demographics, recurrence risk perception of stroke scale, perceived social support scale (PSSS), and health behavior scale for stroke patients (HBS-SP) were used. Correlation analysis was used to examine the relationship between the three variables. The PROCESS macro was used to conduct the mediation analysis. The study was compliant with the STROBE checklist.Results The valid questionnaires were 250 (effective response rate: 98.4%). High recurrence risk perception and high perceived social support were associated with better health behavior (all P Conclusion Perceived social support and recurrence risk perception are promoters of health behavior. Furthermore, the effect of perceived social support on health behavior was partly mediated by recurrence risk perception. Thus, to facilitate long-lasting health behavior, it is vital to provide social support or knowledge of recurrence risk for stroke patients.Practice implications: Healthcare workers and family members can help stroke patients build confidence in the recovery, establish the accurate perception of recurrence risk and improve their health behavior by providing them with multifaceted social support.

Background: Improving meaning in life is beneficial for nursing students to provide better service for patients in the future. As a result, it is important to explore factors affecting meaning in life in nursing students. Objective: To investigate the mediating role of moral identity in the relationship between calling and meaning in life in nursing students. Design: This study was a cross-sectional design. Methods: A total of 10756 nursing students were recruited from November16 to January 17, 2023. The General Demographic Information Questionnaire, the Chinese Calling scale (CCS), the Moral Identity Measure (MIM), and the China Meaning Life Questionnaire (C-MLQ）were used to assess their socio-demographics, calling, moral identity, and meaning in life. Correlation analysis was used to examine the relationship between the three variables. The PROCESS macro was used to conduct mediation analysis. The study was compliant with the STROBE checklist. Results: The valid questionnaires were 10583 (effective response rate: 98.39%). Most of the participants were female(85.47%),unmarried(98.74%) and rural students(79.09%). High moral identity and high calling were associated with better meaning in life (all PConclusion: This study contributes to a broader understanding of the factors that influence nursing students' meaning in life. Calling may influence meaning in life, partly through moral identity. Educators can consider enhancing nursing students' meaning in life by increasing their moral identity and calling.

Background: The effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors on reducing the risk of stroke in patients with type 2 diabetes mellitus (T2DM) remains unclear. Thus, we conducted this systemic review and meta-analysis of all relevant studies and trials to explore the role of SGLT2 inhibitors on the stroke prevention. Methods: The present study included articles published before October 2021 and searched in Web of Science, PubMed databases. We used STATA 12.0 software to compute hazard ratio (HR) and 95% confidence interval (CI). Results: Meta-analysis indicated that SGLT2 inhibitors showed no significant effects on risk of stroke in diabetes in randomized controlled trials with a fixed effects model (HR = 0.98; 95% CI: 0.88–1.09, I2 = 22.3%, p = 0.272). Compared to other glucose-lowering drugs (oGLD) and insulin, SGLT2 inhibitors alone significantly affected risk of stroke in diabetes in observational studies with a random effects model (HR = 0.87; 95% CI: 0.80–0.95, I2 = 72.2%, p < 0.001). Conclusions: In summary, this meta-analysis indicated that the use of SGLT2 inhibitors did not decrease the risk of stroke. And for some T2DM patients with high-risk factor of stroke, SGLT2 inhibitors therapy may be more suitable compared to some oGLD such as dipeptidyl peptidase-4 inhibitors. The results of this meta-analysis are necessary to be confirmed with further studies and clinical trials.

Background Among stroke survivors, the risk of stroke recurrence is high, and stroke survivors' perception of the risk of recurrence is crucial to promote healthy behaviours. Objectives This study aimed to explore the perceptions of stroke survivors about their risk of recurrence and healthy behavioural modifications. Design A qualitative interview study was carried out. Results We interviewed 19 stroke survivors from 3 hospitals. Thematic analysis showed that the perceptions of recurrence risk and healthy behavioural changes differed between first‐ever and recurrent stroke survivors. Three themes were generated from the data of first‐ever stroke survivors: indifference to and unawareness of the risk of stroke recurrence, the need for professional information support and different awareness of the importance of different healthy behaviours. For first‐relapse stroke patients: worry but feel powerlessness towards recurrent event, accurate information is still warranted, regret of unhealthy behaviour patterns. For the survivors suffered two or more times recurrences: perceived severity of recurrences, increased psychological care need, incorrect perceptions of healthy behaviour. Discussion and Conclusion Stroke survivors with or without recurrence hold different perceptions towards the risk of recurrence and behavioural changes. The need for information related to warning signs, recurrence risk and risk factors remained consistently unmet. The benefits of healthy behaviours could be a double‐edged sword for the prevention of stroke recurrence if the survivors fail to understand these accurately. It is strongly recommended that a specific recurrence risk communication tool and related health education plan be explored on the basis of the number of times patients have experienced stroke recurrence to inform secondary prevention of stroke in the future. Patient/Public Contribution The patients were involved in the formulation of interview questions and conduct of this study. No public was involved in this study.

AIMS To understand how survivors of stroke perceive secondary prevention and explore their perceived barriers and facilitators using the Theoretical Domains Framework. DESIGN A qualitative descriptive study. METHODS Nineteen survivors of stroke from three hospitals were recruited and interviewed from April 2019 to April 2020. The data were analysed deductively and inductively by content analysis strategies. RESULTS Three main themes of perception of secondary prevention were identified, these being active treatment-seeking, attention to taking medications and negative attitude towards lifestyle changes. Using deductive analysis, eight domains of the Theoretical Domains Framework were reported to be relevant in the secondary prevention behaviour of survivors of stroke that mapped to five 'barrier' domains (i.e. knowledge, physical skills, beliefs about capability, beliefs about consequences and optimism) as well as six 'facilitator' domains (i.e. knowledge, interpersonal skills, beliefs about capability, intention, emotion and social influences). Using inductive analysis we identified two additional important factors not falling in the domains of the Theoretical Domains Framework. These comprised female spouses' support and patients' economic autonomy, both of which could be classified as a facilitator or barrier. CONCLUSION Survivors of stroke perceive seeking treatment and using preventive medication as more important than modifying lifestyle behaviours. Knowledge and insight into the barriers and facilitators of secondary prevention in this specific context provides a theoretical and practical basis for the design of future secondary prevention interventions. IMPACT Stroke survivors' perceptions of secondary prevention, barriers and facilitators were explored in the context of a developing country. These findings highlight the need to better communicate the importance of improving lifestyle modification and medication adherence, and provide evidence for designing relevant interventions for stroke management in the community.

Background There were few studies exploring the associations between depressive symptoms, anxiety symptoms and health-related quality of life (HRQoL) in the general population, especially in resource limited area. The aims of this study were to assess the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL in rural area. Methods A total of 23,496 eligible participants from Henan rural cohort were included. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were employed to assess depressive and anxiety symptoms, respectively. HRQoL was measured via European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). Tobit regression and generalized linear model were utilized to explore the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL. Results A total of 1320 individuals were identified as depressive symptoms with a prevalence rate of 5.62%, while 1198 participants were classified as anxiety symptoms with a prevalence rate of 5.10%. After multiple adjustment, the regression coefficients (β) and 95% confidence interval (CI) of utility index for depressive and anxiety symptoms were − 0.166 (− 0.182, − 0.149) and − 0.132 (− 0.149, − 0.114), respectively. The β and 95% CI of VAS score for depressive and anxiety symptoms were − 7.65 (− 8.60, − 6.70) and − 5.79 (− 6.78, − 4.80), respectively. Additionally, the comorbidity was strongly associated with low utility index and VAS score. These findings were observed robustly in men and women. Conclusion Depressive symptoms, anxiety symptoms and their comorbidity were associated with low HRQoL in rural population, which needed further efforts on preventive and treatment interventions. Clinical trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015.

Innovation is essential to advance nursing and health care. However, few studies have focused on innovative behavior of nursing students.The purpose of this study was to explore the mediating effects of creative self-efficacy and achievement motivation on the relationship between clinical practice environment and innovative behavior in Bachelor of Science in Nursing (BSN) students.A descriptive cross-sectional study using an online questionnaire.Participants were recruited online from five practice hospitals in Henan Province, China.A total of 588 BSN students enrolled in the study.The participants completed the innovative behavior questionnaire, the clinical practice environment scale, the achievement motivation scale, and the creative self-efficacy scale online in 2022. SPSS PROCESS macro was used for data analysis. The reporting followed the STROBE checklist.A total of 499 valid questionnaires were collected. A positive clinical practice environment was associated with more innovative behavior, and this relation was partially mediated by creative self-efficacy and motive to avoid failure.Our study complements the evidence on the mechanism of action between the clinical practice environment and innovative behavior. Our findings have important implications for nursing educators to develop education strategies to inspire nursing students to pursue innovations in school and clinical settings.

To translate the MOSE from English to Chinese and investigate the psychometric properties of the Chinese-translated version of the Measure of Stroke Environment (MOSE).The MOSE was translated into Chinese using a cultural adaptation process. To validate this Chinese version, 311 stroke survivors were recruited to complete the questionnaire. The psychometric properties of the MOSE were evaluated by determining item analysis, test-retest reliability, internal consistency, content validity, construct validity, and floor/ceiling effects, respectively.The MOSE was translated without any major difficulties. Regarding psychometric performances, a moderate level of correlation between the items and the domains (This study provides psychometric evidence supporting the use of the Chinese version of the MOSE among stroke survivors.IMPLICATIONS FOR REHABILITATIONThe Measure of Stroke Environment was translated into Chinese through a rigorous cultural adaptation process.MOSE-C is now a reliable and valid tool for Chinese-speaking survivors who have suffered from a stroke.It is necessary to assess the perceived environmental barriers of stroke survivors and develop targeted intervention programs in China.

Objective:This study was to investigate the potential protective effects of curcumin in cerebral ischemia-reperfusion (CIR) and its regulation of miR-7.Methods:Rats were occluded by middle cerebral artery occlusion (MCAO) for 1.5 h and reperfused for 2 h to establish a local CIR model. After 24 hours of model establishment, MCAO rats were given curcumin for 3 days by intragastric administration. PC12 cells were cultured for 6 h in oxygen-glucose deprivation medium and then reoxygenated for 24 h to establish an oxygenglucose deprivation/reoxygenation (OGD/R) model. The OGD/R model cells were treated with curcumin for 48 h.Results:Curcumin inhibited the decrease of miR-7-5p expression and an increase of RelA p65 expression induced by CIR and ODG/R. RelA p65 was a target of miR-7-5p. MiR-7-5p antagonists were able to counteract the effect of curcumin on the expression of RelA p65 in ischemic brain tissue of MCAO rats and OGD/R model cells. Curcumin improved OGD/R-induced inhibition of cell activity, necrosis and apoptosis. Curcumin significantly reduced the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-1β, reactive oxygen species (ROS) and malondialdehyde (MDA) and increased the activity of superoxide dismutases (SOD) and catalase (CAT) in OGD/R-induced cells. Curcumin may inhibit OGD/R-induced cell damage by regulating miR-7-5p. Curcumin improved cerebral infarction, nerve damage and cognitive dysfunction in rats with CIR, which may be related to the regulation of miR-7-5p/RelA p65 axis.Conclusion:Curcumin exerts cerebral protection by attenuating cell necrosis and apoptosis, inflammatory response and oxidative stress following CIR, which may be related to its regulation of the miR-7/RELA p65 axis.

IntroductionStroke is known as one of the leading causes of mortality and disability worldwide. Self-care plays a significant role in improving the quality of life, self-efficacy and many other outcomes of stroke survivors. However, it is a dyadic phenomenon where patient self-care and the caregiver contribution to self-care are inter-related in terms of predictors and outcomes. Currently, there is still no systematic assessment conducted to examine the overall effectiveness of self-care interventions carried out in stroke survivor–caregiver dyads and explore the effect on stroke survivor and/or caregiver outcomes.MethodsWe plan to conduct a systematic review and meta-analysis of the evidence regarding the self-care interventions carried out in stroke survivor–caregiver dyads. We will undertake a systematic search of multiple databases including PubMed, Web of Science, CINAHL, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials and four Chinese databases (CNKI, CBM, WANFANG and VIP) from inception to July 2021 for the purpose of collecting the relevant articles. The eligible studies are defined as those original researches, written in English or Chinese, on self-care interventions in stroke survivor–caregiver dyad samples. Two independent researchers will be deployed to identify the eligible trials according to the selection criteria and extract the relevant data. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist has been used for this protocol. We will use the Cochrane Risk for Bias tool to assess the risk of bias for randomised controlled trials.Ethics and disseminationIn our review, any identifiable patient data will be excluded, which removes the need for ethical approval and participant consent. The final results of our study will be published in an open-access peer-reviewed journal, and abstract will be presented at suitable national/international conferences.PROSPERO registration numberCRD42021239824.

AIMS AND OBJECTIVES To investigate the status of physical activity and exercise (PAE) adherence and identify its influential factors among community-dwelling stroke survivors. BACKGROUND Regular PAE after stroke is essential for recovery and secondary prevention, while adherence to PAE and its influential factors are rarely studied. DESIGN A cross-sectional descriptive study. METHODS In total, 208 stroke survivors (70.25 ± 9.08 years) were randomly selected from three communities. The influential factors of PAE adherence and associations between these variables were explored using multiple linear regression and path analyses. This study adhered to the EQUATOR checklist, STROBE. RESULTS The mean adherence rate was moderate (62.00%), and stroke survivors tended to be more adherent to PAE than monitoring and seeking advice (70.30%>53.50%>48.30%). The regression results revealed that seven factors were significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience and times since stroke. Furthermore, the path analysis showed that knowledge had a significant indirect positive influence on adherence with self-efficacy as a mediator, while attitude and social support impacted both directly and indirectly with self-efficacy as the mediator. Moreover, self-efficacy had the most substantial direct effect on community-dwelling stroke survivors' PAE adherence. These four variables accounted for a total of 67.00% of the variance in PAE adherence among community-dwelling stroke survivors. CONCLUSIONS The PAE adherence of community stroke survivors needs to be improved. Healthcare professionals should develop more effective interventions to promote PAE adherence through enhancing self-efficacy among this population. RELEVANCE TO CLINICAL PRACTICE Adherence to the recommended regimen is the most challenging dimension of stroke physical activity and exercise. This study contributes to exploring status and influential factors of PAE adherence, and self-efficacy was found to be a significant determinant. The results could be used to inspire future community-based intervention programs for stroke survivors.

Background: There were few studies exploring the associations between depressive symptoms, anxiety disorders and health-related quality of life (HRQoL) in the general population, especially in resource limited area. The aims of this study were to assess the associations between depressive symptoms, anxiety disorders, their comorbidity and HRQoL in rural area.Methods: A total of 23496 eligible participants from Henan rural cohort were included. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were employed to assess depressive symptoms and anxiety disorders, respectively. HRQoL was measured via European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). Tobit regression and generalized linear model were utilized to explore the associations between depressive symptoms, anxiety disorders, their comorbidity and HRQoL.Results: A total of 1320 individuals were identified as depressive symptoms with a prevalence of 5.62%, while 1198 participants were classified as anxiety disorders with a prevalence of 5.10%. After multiple adjustment, the regression coefficients and 95% confidence interval (CI) of utility index for depressive symptoms and anxiety disorders were -0.166 (-0.182, -0.149) and -0.132 (-0.149, -0.114), respectively. The regression coefficients and 95% CI of VAS score for depressive symptoms and anxiety disorders were -7.65 (-8.60, -6.70) and -5.79 (-6.78, -4.80), respectively. Additionally, the comorbidity was strongest associated with low utility index and VAS score. These findings were observed robustly in men and women.Conclusion: Depressive symptoms, anxiety disorders and their comorbidity were negatively associated with HRQoL in rural population, which needed further efforts on preventive and treatment interventions.Clinical Trial Registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375

ObjectivesUnderstanding the unmet needs of community-dwelling stroke survivors is essential for further intervention. This systematic review was performed to summarise their unmet needs from a quantitative viewpoint.DesignSystematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesA comprehensive search of six databases was conducted from inception to February 2020: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and CBM. The methodological quality of the studies was assessed. Unmet needs were categorised, and a pooled analysis of the main outcomes was conducted.Eligibility criteria for selecting studiesWe included quantitative studies focused on the unmet needs of stroke survivors who live at homes rather than in any other institutionalised organisation.ResultsIn total, 32 of 2660 studies were included, and 1980 unmet needs were identified. The prevalence of patients with unmet needs ranged from 15.08% to 97.59%, with a median of 67.20%; the median number of unmet needs per patient ranged from 2 to 8 (0–31). The prevalence of unmet needs was high at 6 months post-stroke (62.14%) and 2 years post-stroke (81.37%). After categorisation, the main concerns among these patients were revealed to be information support, physical function and mental health; a few studies reported unmet needs related to leisure exercise, return to work and so on. Additionally, differences in the measurement tools used across studies affect what unmet needs participants report.ConclusionsSufficient, accurate, individualised and dynamic information support is a priority among community-dwelling stroke survivors. Physical function and mental health are also the most significant concerns for re-achieving social participation. It is essential to design and disseminate standard, effective and time-saving tools to assess unmet needs.Trial registration numberCRD42018112181.

The aims were to identify the possible influencing factors of health-related quality of life (HRQoL) and its domain-specific scores in patients with coronary heart disease (CHD). A total of 1247 patients with CHD from the Henan Rural Cohort Study (n = 39,259) were included in this study. The Chinese version of the European Quality of Life Five Dimension Five level scale (EQ-5D-5L) and Visual Analogue Scale (VAS) were used to evaluate HRQoL in patients with CHD. Tobit regression, generalized linear models and binary logistic regression were applied to determine the potential factors influencing the EQ-5D utility, as well as each domain, and the VAS. CHD patients had lower per capita monthly actual income, and higher rates of diabetes mellitus, stroke, anxiety and poor sleep quality, which significantly decreased EQ-5D index and VAS scores. In addition, sex, older age, education, not having a spouse, ever drinking alcohol, a high-fat diet, physical activity, hypertension and depression affected the various domain-specific EQ-5D scores in CHD patients. CHD patients in rural areas have a lower HRQoL. Factors associated with the EQ-5D index, including each domain, and the VAS need attention. CHD patients in rural areas need to be managed systematically.

Yongli Wang,1,2 Janet Krska,3 Beilei Lin,1 Yongxia Mei,1 Barbra Katusiime,3 Yawen Guo,1 Zhenxiang Zhang1 1School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 2Peking University People’s Hospital, Beijing, People’s Republic of China; 3Medway School of Pharmacy, The Universities of Kent and Greenwich at Medway, Chatham, Kent, UKCorrespondence: Zhenxiang ZhangSchool of Nursing and Health, No. 100 Science Avenue, Zhengzhou, Henan, People’s Republic of ChinaTel +86 13303816666Fax +86 371-86565001Email zhangzx6666@126.comBackground: The Living with Medicines Questionnaire (LMQ-3) is a reliable, valid instrument used to assess the medication-related burden of patients with chronic disease using long-term medication, but it has not been used in China.Purpose: To translate and cross-culturally adapt the LMQ-3 into Chinese and assess its reliability and validity among elderly patients with chronic disease.Methods: After translation and back-translation, views from an expert group and cognitive interviews with elderly persons using multiple medicines were used to ensure the cultural relevance of the LMQ-3. Then, 412 participants aged 60– 92 years were recruited from three communities in Zhengzhou to complete the instrument. Item analysis, internal consistency, content validity, exploratory factor analysis (EFA) and reliability testing were performed.Results: Item analysis identified nine items for possible removal, which were discussed with the originating team. Internal consistency testing confirmed the suitability of removing two of these items, which concurred with the views of the expert group and cognitive interviews. All other items were retained, but four were modified for clarification without changing their meaning, resulting in a 39-item instrument. EFA of this 39-item measure yielded an eight-factor model, similar to the English version. Cronbach’s alpha of the Chinese version of LMQ-3 (C-LMQ-3) for elderly patients with chronic diseases was 0.855, and alpha values for the eight domains ranged from 0.822 to 0.932. Test–retest reliability was satisfactory, with ICC values for the eight domain scores ranging from 0.751 to 0.881.Conclusion: With only minor modifications compared to the English version, the 39-item C-LMQ-3 is a valid tool, with adequate reliability, which can be used to assess the medication-related burden of long-term use of multiple medicines in elderly patients in China.Keywords: reliability, cultural adaptation, medicine burden, patient-reported outcome, multi-morbidity, Living with Medicines Questionnaire

Introduction: Stroke-related smartphone applications (apps) present enormous potential for stroke management as apps become increasingly prevalent in China. However, there is no comprehensive study reported about the currents status of stroke-related apps available to adopt in Chinese app market. The aim of this study is to assess the current status of stroke-related apps available to adopt in China. Materials and Methods: Using Stroke-related keywords written in either Chinese or English, the top 6 most prevalent apps online stores in China were searched from June to August 2018, including android market, 360 app market, wan dou jia, baidu mobile app, ying yong bao, apple app store. The basic features of selected apps were analyzed based on operating system, cost, target people, engagement, online interaction, release date, size, popularity, and usefulness. The information accountability of selected apps was evaluated with the Silberg scale. The functionality of selected apps targeting stroke patients at home were reviewed by researchers. Results: Our study showed that the downloads of stroke-related apps from android platform and the engagement of health professionals in apps development were critically insufficient. And most apps didn’t offer a platform to facilitate online interaction with health professional. The information accountability of apps also presented a huge room for improvement. The average Silberg score of 127 apps was 3.5 (out of 9) with most apps not disclosing sponsorship, authors’ affiliations, credentials, and sources or references of information. Few apps were modified in the past months. What's more, although the apps targeting stroke patients at home have covered 9 functionalities, most apps had only a simple functionality. Conclusion: This study identified areas for improvement concerning information accountability of stroke-related apps available for adoption in China and reviewed functionality of apps targeting stroke patients at home. The findings might guide the development for stroke-related apps in China in the future.

Background: Regular physical activity and exercise (PAE) after stroke is essential, but the adherence to PAE and its influential factors is rarely studied and unclear in developed countries. The aim of this study was to investigate the status of PAE adherence, and to identify its influential factors among Chinese community-dwelling stroke survivors.Methods: A cross-sectional study was conducted, 208 stroke survivors were randomly selected from three communities (60.10% men, mean age 70.25 ± 9.08 years). Physical Activity and Exercise Adherence Scale (PAEAS) was used as a measure of compliance, knowledge, attitude, self-efficacy and social support were measured using relevant scales. Influential factors of PAE adherence and associations between those variables were explored using multiple linear regression and path analysis.Results: The mean adherence rate was moderate (62.0%), stroke survivors tended to be more adherent to do PAE than monitoring and seeking advices (70.30% > 53.50% > 48.30%). Regression results revealed that seven factors significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience, and times since stroke (R2 = 75.10%, F = 45.593, p < 0.05). Furthermore, path analysis showed that knowledge had a significant indirect positive influence with self-efficacy as a mediator on adherence (β= 0.16, p < 0.05); while attitude and social support impacted both directly and indirectly on adherence with self-efficacy as the mediator; what’s more, self-efficacy was an important predictor that performed the strongest direct effect on community-dwelling stroke survivors’ PAE adherence (β= 0.44, p < 0.01 ). These four variables accounted for a total of 67.00% of the variance of PAE adherence among community-dwelling stroke survivors.Conclusions: Physical activity and exercise adherence of community stroke survivors is needed to be improved. Attitude and social support presented both direct and indirect impacts on PAE adherence through self-efficacy, while knowledge only exhibited an indirect influencing effect on adherence. Health care professionals should administer a more comprehensive and systematic assessment to seek to improve self-efficacy through the development of effective interventions for promoting adherence to PAE in this population.

The aim of this study is to describe a longitudinal research protocol for exploring the relationship of dyadic appraisal, dyadic coping (DC), and dyadic mental health among stroke survivors and their spouses and its action path.Stroke can be considered as a dyad phenomenon which affects the mental health of both the survivors and their spouse caregivers. Studies based on dyadic theories are needed to examine the roles of dyadic appraisal and DC on the mental health of stroke dyads.Longitudinal study.Stroke survivors and their spouse caregivers will be recruited from hospital, when the survivors are stable and about to discharge. Follow-up assessments will take place in 3, 6, 9, and 12 months after participants discharge. The structural equation modelling will be used for statistic analysing.Our study seeks to expand the theory of Developmental-Contextual Model to examine the association among variables including dyadic appraisal, DC, and mental health for the couples coping with stroke.目标: 本研究旨在探讨中风存活者及其配偶之间的二元评估、二元应对(DC)和二元心理健康关系的纵向研究方案及其行为路径。 背景资料: 中风可以被认为是一种二元现象,影响幸存者及其配偶照护者的心理健康。需要基于二元理论的研究来检验二元评估和二元应对在中风二元患者心理健康中的作用。 设计: 纵向研究。 方法: 从医院招募病情稳定并即将出院的中风幸存者及其配偶照顾者。将在参与者出院后的3、6、9和12个月内进行随访评估。将使用结构方程模型进行统计分析。 讨论: 本研究试图扩展发展情境模型的理论,以检查变量之间的联系,包括应对中风夫妇的二元评价、二元应对和心理健康问题。.

To verify the effectiveness and feasibility of a nine-week benefit-finding intervention on the burden, quality of life, and benefit finding of caregivers, as well as on the quality of life of strok...

Health literacy is the ability of individuals to access, process, and understand health information to make decisions regarding treatment and their health on the whole, it is critical to maintain and improve public health. However, the health literacy of urban and rural populations in China has been little known. Thus, this study aims to assess the status of health literacy and explore the differences of its possible determinants (e.g., socio-economic factors) among urban and rural populations in Henan, China. A cross-sectional study, 78,646 participants were recruited from a populous province in central China with a multi-stage random sampling design. The Chinese Resident Health Literacy Scale was adopted to measure the health literacy of the respondents. In the participants, the level of health literacy (10.21%) in central China was significantly lower than the national average, and a big gap was identified between urban and rural populations (16.92% vs. 8.09%). A noticeable difference was reported in different aspects and health issues of health literacy between urban and rural populations. The health literacy level was lower in those with lower levels of education, and a significant difference was identified in the level of health literacy among people of different ages and occupations in both urban and rural areas. Note that in rural areas, as long as residents educated, they all had higher odds to exhibit basic health literacy than those uneducated, in rural areas, compared with those aged 15 to 24 years, residents aged 45 to 54 years (OR = 0.846,95% CI (0.730, 0.981)), 55 to 64 years (OR = 0.716,95% CI (0.614, 0.836)) and above 65 years (OR = 0.679, 95% CI (0.567, 0.812)) were 84.6%, 71.6%, and 67.9%, respectively, less likely to exhibit basic health literacy. Considering the lower health literacy among rural residents compared with their urban counterparts, a reorientation of the health policy-making for Chinese rural areas is recommended. This study suggests that urban&ndash, rural disparity about health literacy risk factors should be considered when implementing health literacy promotion intervention.

Stroke is still the main cause of death and disability worldwide, numerous studies of recurrence risk have been reported, while systematic estimates of stroke recurrence risk in the last 10 years are variable. This review aims to estimate the cumulative stroke recurrence risk in the last 10 years for secondary prevention management in future. A systematic search from January 2009 to March 2019 was conducted through PubMed, EMBASE, Web of Science, Wan-fang, and CNKI. Search terms were in English and Chinese. A total of 37 studies involving 1,075,014 stroke patients were included. The pooled stroke recurrence rate was 7.7% at 3 months, 9.5% at 6 months, 10.4% at 1 year, 16.1% at 2 years, 16.7% at 3 years, 14.8% at 5 years, 12.9% at 10 years, and 39.7% at 12 years after the initial stroke. In addition, the pooled recurrence rate of 32 studies including stroke patients over 50 years only at seven time points except for subgroup of 10 years was 7.7%, 9.5%, 11.2%, 16.1%, 19.3%, 18.1%, and 39.7%, respectively. Meta-regression showed that the time points explained 23.02% of the variance among studies, while regions, age, and stroke types showed no significant contribution to heterogeneity. The risk of stroke recurrence varies greatly from 3 months to over 10 years and increases significantly over time in both young and old subgroup. The heterogeneity may be explained by follow-up time, regions, age, methodology differences, and stroke types, which was needed further exploration in future.

BACKGROUND Cerebral ischemia-reperfusion injury (CIRI) remains a serious health problem. Centella asiatica formulations are used to treat central nervous system disorders. In the present study, asiaticoside, an extract of the plant Centella asiatica, was investigated in CIRI in vivo and vitro. MATERIAL AND METHODS We made a CIRI model in vivo in SD rats treated by middle cerebral artery occlusion, and a cell model of ischemia-reperfusion injury was made in PC12 cells treated by deprivation of oxygen and glucose/restoration. CIRI in vivo was assessed by scores of neurological functions, encephaledema, and cerebral infarction area. Inflammation level and oxidative stress level were detected by the appropriate kits. TUNEL assay was performed for assessment of cell apoptosis and Western blot analysis was performed to assess protein expression levels. CCK8 assay was performed for evaluation of cell survival and flow cytometer was used to detect cell apoptosis in vitro. RESULTS Nervous function injury, brain edema, cell apoptosis, infarct size, apoptosis-related protein expressions, and protein expressions of the NOD2/MAPK/NF-kappaB signaling pathway in the CIRI model were all reversed by asiaticoside in rats. The cell apoptosis, inflammation level, and oxidative stress level in the model of cerebral ischemia-reperfusion injury were reduced by asiaticoside. The effects of asiaticoside on CIRI were reversed by NOD 2 agonists. CONCLUSIONS Asiaticoside showed a protective effect against cerebral ischemia-reperfusion injury via the NOD2/MAPK/NF-kappaB signaling pathway. These findings are vital for future research on use of asiaticoside in CIRI, providing a new avenue for alleviating CIRI.

Aims and objectives To identify whether benefit finding is a mediator or moderator in the relationship between caregiver burden and psychological well-being (anxiety and depression) in Chinese family caregivers of community-dwelling stroke survivors. Background Family caregivers not only bear a heavy burden, a high level of anxiety and depression, but also experience benefit finding (positive effects result from stressful events). However, the relationships among benefit finding, caregiver burden and psychological well-being in Chinese family caregivers are not well known. Design This study was a cross-sectional correlational design. Methods Caregivers (n = 145) of stroke survivors were recruited from two communities in Zhengzhou, China. Data were collected by face-to-face interviews with structured questionnaires, examining caregiver burden, benefit finding and psychological well-being of caregivers. A hierarchical regression analysis explored whether caregiver burden and benefit finding were associated with anxiety and depression of caregivers. The moderator role of benefit finding was examined by testing the significance of the interaction between caregiver burden and benefit finding. A mediational model was used to test benefit finding as a mediator between caregiver burden and psychological well-being of caregivers using process in spss 21.0. Results Caregiver burden and benefit finding were significantly associated with both anxiety and depression of caregivers. Benefit finding did not portray a moderating role, but portrayed the mediator role in the relationship between caregiver burden, anxiety and depression in caregivers. Conclusion This study provides the preliminary evidence to nurses that intervention focus on benefit finding may help improve the psychological well-being of caregivers. Relevance to clinical practice This study offers nurses rational for assessing caregiver's negative emotions and benefit finding. By targeting benefit finding, the nurse may guide caregivers in benefit identification and implement interventions to reduce anxiety, depression and caregiver burden.

IntroductionStroke is a leading cause of disability worldwide. The average hospital length of stay ranges from 3 to 28 days, and after discharge home the stroke survivors will live with physical, cognitive, even psychological disorders for the rest of their lives. It is essential to review the unmet needs of stroke survivors.Methods and analysisA systematic review of previous quantitative and qualitative studies reporting the unmet needs of stroke survivors in their homes will be conducted. The following six databases will be searched from inception to December 2018 for relevant articles: PubMed, EMBASE, CINAHL, PsycINFO, SCOPUS and China Biology Medicine. We will include studies limited to human and published in English or Chinese, and the patients with stroke should discharge home rather than any other professional organisations including nursing homes or community rehabilitation units and so on. Data of quantitative research will be standardised for comparison, thematic analysis will be used for qualitative data and a narrative synthesis and pooled analysis of the main outcomes will be reported.Ethics and disseminationThis review will be submitted to an international professional journal, and the detailed search strategies and analysis flowchart will be openly included as supplements. This study does not require ethical approval as no patient’s identifiable data will be used. Our findings will give a new look at the aspect of stroke survivors’ unmet needs in their long-term recovery stage, especially the trajectories of unmet needs at different timepoints. What is more, this review will demonstrate the long-term unmet needs of stroke survivors from different countries, will compare any variations between high-income and low-income regions, and the geographical differences of needs will be mapped if necessary. We will endeavour to provide as much information as possible to healthcare professionals and public health policy makers in order to promote further medical reform.Trial registration numberCRD42018112181.

The unmet needs perceived by community-dwelling stroke survivors may truly reflect the needs of patients, which is crucial for pleasant emotional experiences and a better quality of life for community-dwelling survivors not living in institutionalized organizations. The purpose of the study is to identify the scope of unmet needs from the perspectives of stroke patients in the community. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. Six electronic databases were searched from inception to February 2020. A total of 24 articles were involved, providing data on 378 stroke survivors. Eight categories were derived from 63 findings, and then summarized into four synthesized findings based on the framework of ICF: (1) unmet needs regarding with the disease-related information; (2) unmet physical recovery and activity/participation needs; (3) unmet needs for social environmental resources; (4) unmet psycho-emotional support needs. We found the framework of ICF mostly complete, but unmet information needs still remain. The needs that are mainly unsatisfied include physical, psychosocial and informational, as well as the practical support from professional or environment resources. The ever-present unmet needs perceived by community-dwelling stroke survivors who do not live in institutions are discoverable and mitigable. Future studies should focus on quantifying unmet needs comprehensively derived from experiential domains, assessing the rationality of the unmet needs expressed by patients’ perspectives and developing flexible strategies for long-term and changing needs.